MEDICARE: NAVID S SIDDIQUI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RS0012X	Sleep Medicine (Internal Medicine) Physician	115197	MO
2	2083B0002X	Obesity Medicine (Preventive Medicine) Physician	115197	MO
3	207R00000X	Internal Medicine Physician	115197	MO

General Provider Information

NPI Number	:	1083692677
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NAVID S SIDDIQUI MD

Provider Business Mailing Address
First Line	:	PO BOX 955534
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63195-5534
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12255 DE PAUL DR STE 600
Second Line	:
City	:	BRIDGETON
State	:	MO
Zip	:	63044-2515
Country	:	US
Telephone Number	:	314-209-5100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2006
Last Update Date	:	01/10/2024

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